Scribd
Upload
277 views1 page

Form For IVT Training

This document summarizes a 3-day basic intravenous therapy training program for nurses. It lists the name of the registered nurse who attended, their PRC number and expiration date, the hospital that offered the training, and the dates the training was held. It documents the nurse's successful completion of requirements to initiate and maintain peripheral IV infusions on 3 patients, administer intravenous drugs to 1 patient, and administer and maintain blood and blood components to 1 patient under the supervision of certified trainers.

Uploaded by

Jay Mee
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
277 views1 page

Form For IVT Training

This document summarizes a 3-day basic intravenous therapy training program for nurses. It lists the name of the registered nurse who attended, their PRC number and expiration date, the hospital that offered the training, and the dates the training was held. It documents the nurse's successful completion of requirements to initiate and maintain peripheral IV infusions on 3 patients, administer intravenous drugs to 1 patient, and administer and maintain blood and blood components to 1 patient under the supervision of certified trainers.

Uploaded by

Jay Mee
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 1

3+3+1 ACCOMPLISHED REQUIREMENTS of

3 DAY BASIC INTRAVENOUS THERAPY TRAINING PROGRAM for NURSES


Name of Registered Nurse:
PRC Number/Expiry Date:
Name of Hospital offering IV Training: Ilocos Training and Regional Medical Center
Provider No.: 129 Valid until January
9, 2015
Date of IV Training Program Attended: September 6, 7 & 8, 2013
Venue: Ilocos Training and Regional
Medical Center
I.
Patient
Numbe
r

II.
Patien
t
Numb
er

III.
Patie
nt
Numb
er

Initiating/ Maintaining Peripheral IV infusions


Name of Patient

Ag
e

Date

Time

Kind
of
Infusi
on

Type of
Cannula

Site

Dose

Rate

Signature over Printed


name of Certified
Trainer/ Preceptor

IV
License
No.

Signature over Printed


name of Certified
Trainer/ Preceptor

IV
License
No.

Signature over Printed


name of Certified
Trainer/ Preceptor

IV
License
No.

Administering Intravenous Drugs


Name of
Patient

Ag
e

Date

Time

Drugs
Incorporat
ed

Dose

Diagnosis

Administering and Maintaining Blood and Blood Components


Name of
Patient

Ag
e

Date

Submitted by:
on sick leave
Signature over Printed Name
RN, MANc

Tim
e

Volume/ Blood Type


Component/ Rate/
Serial#

Date submitted:

Site

Type of
Cannul
a

Received by:

Diagnosis

Approved by:
Emilia Zenaida G. Robles,
Director, Nursing Services
By: Flordeliza R. Bobiles, R.N., MAN
OIC-Chief Nurse, Nursing Services

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy